MANEJO DE LA EMPATÍA EN LA INTERCONSULTA
Resumen
La interconsulta representa una modalidad clínica y una herramienta metodológica útil para la mejora de la calidad de atención de los pacientes internados (Santos, Slonczewski & Prebianchi, 2011; Pincus, 1987). Sin embargo, aquellos profesionales que no han desarrollado las capacidades de afrontamiento necesarias para abordar las situaciones de gran carga emocional que suelen presentar los pacientes con dolor, están más expuestos a desarrollar síntomas de malestar personal o síndrome de burnout, lo que impacta negativamente en el tratamiento (Rushton, Kaszniak & Halifax, 2013; Vidal y Benito 2012). Diversos Investigadores ubican la importancia del manejo de la empatía como recurso fundamental frente a estos obstáculos (Cano, Leong, Williams, Dana & Jillian, 2012; Lamm, Batson & Decety, 2007; Rushton et al. 2013; Vidal y Benito, 2012). En el presente estudio se realiza una revisión de trabajos sobre la empatía, analizando su relación con el abordaje de pacientes con dolor. Hafilax (2011) señala que la capacidad de empatía, la diferenciación del self y de las experiencias, y la ética son variables asociadas -según su estabilidad- a una diferente toma de perspectivas, y por ende, a distintas respuestas frente al paciente con dolor. Cuando los profesionales logran ubicar el sufrimiento del paciente como separado de ellos mismos, con un claro reconocimiento de que aquel sufrimiento no es el suyo -existiendo una resonancia empática- pueden sentirse capaces de entrar en el mundo del paciente y su enfermedad; con firmeza personal y profesional. Se presenta un caso clínico.
Palabras Clave: Interconsulta, Empatía, Dolor
Title: EMPATHY MANAGEMENT IN CONSULTATION-LIAISON PSYCHIATRY
Abstract:
Consultation-liaison psychiatry represents a clinical modality and a useful methodological tool to improve inpatients´ quality of care (Santos, Slonczewski & Prebianchi, 2011; Pincus, 1987). However, those professionals who have no gained the necessary coping skills to address the situations of great emotional burden that are often presented by patients with pain, are more likely to develop personal distress symptoms or burnout syndrome, which impacts negatively in the treatment (Rushton, Kaszniak & Halifax, 2013; Vidal y Benito 2012). Different researchers address the importance of empathy management as a key resource against this obstacles (Cano, Leong, Williams, Dana & Jillian, 2012; Lamm, Batson & Decety, 2007; Rushton et al. 2013; Vidal y Benito, 2012). This paper reviews works which study empathy, and analyzes its relationship with the treatment of patients with pain. Hafilax (2011) notes that the ability to empathize, the differentiation of self and experiences, and ethics are variables associated –according to their stability- to a different perspective taking, and thus, to different responses to a patient in pain. When professionals manage to address the patient's suffering as something separate from themselves, with a clear recognition that this suffering is not their own –and there is empathic resonance – they can feel able to enter the patient´s world and their disease and remain personally and professionally grounded. A case is presented.
Key words: Consultation-liaison psychiatry, Empathy, Pain
Citas
Batson, C., Early, S. & Salvarani, G. (1997). Perspective taking: Imagining how another feels versus imagining how you would feel. Personality and Social Psychology Bulletin, 23, 751-758.
Batson, C., Fultz, J. & Schoenrade, P. (1987). Distress and empathy: Two qualitatively distinct vicarious emotions with different motivational consequences. Journal of Personality, 55(1), 19–39.
Beck, A., Rush, A., Shaw, B. & Emery, G. (1983). Terapia Cognitiva de la Depresión. New York: The Gilford Press.
Bennett-Levy, J., Thwaites, R., Chaddock, A. & Davis, M. (2009). Reflective practice in cognitive behavioural therapy: the engine of lifelong learning. En: Stedmon J & Dallos R (Eds.), Reflective Practice in Psychotherapy and Counselling (pp. 115–135). Maidenhead: OpenUniversity Press.
Cano, A., Leong, E., Williams, A., Dana, K. & Jillian R. (2012). Correlates and consequences of the disclosure of pain-related distress to one’s spouse. PAIN: 153, 2441–2447.
Cialdini, R., Schaller, M., Houlihan, D., Arps, K., Fultz, J. & Beaman, A. (1987). Empathy-based helping: Is it selflessly or selfishly motivated?. Journal of Personality and Social Psychology, 52, 749-758.
Dimberg, U. & Oehman, A. (1996). Behold the wrath: Psychophysiological responses to facial stimuli. Motivation and Emotion, 20, 149–182.
Eisenberg, N. (2002). Distinctions among various modes of empathy related reactions: A matter of importance in humans. Behavioral Brain Sciences, 25(1), pp33–34.
Fernández-Álvarez, H. (2008). Integración y Salud Mental. El proyecto Aiglé. Bilbao, España: Desclée de Brouwer.
Finkenauer C. & Rime B. (1998) Socially shared emotional experiences versus emotional experiences kept secret: differential characteristics and consequences. Journal of Social Clinical Psychology, 17, 295–318.
García-Campayo, J. & Rodero, B. (2011). La catastrofización ante el dolor en la fibromialgia. Jano, 60, 59-61 Recuperado de:
http://www.jano.es/ficheros/sumarios/1/00/1772/59/1v00n1772a90021171pdf001.pdf
Goubert, L., Craig, K., Vervoort, T., Morley, S., Sullivan, M., Williams, A., (…) & Crombez, G. (2005). Facing others in pain: the effects of empathy. PAIN, 118, 285–288.
Halifax, J. (2011). The precious necessity of compassion. Journal of Pain Symptom Management, 41, 146–153.
Iacoboni, M. (2009). Las neuronas Espejo. Madrid, España: Katz Ediciones
Kahn, J. & Hessling, R. (2001). Measuring the tendency to conceal versus disclose psychological distress. Journal of Social Clinical Psychology, 20, 41–65.
Lamm, C., Batson, C., & Decety, J. (2007). The neural substrate of human empathy: Effects of perspective-taking and cognitive appraisal. Journal of Cognitive Neuroscience, 19,42-58.
Laurenceau, J., Barrett, L. & Pietromonaco, P. (1998). Intimacy as an interpersonal process: the importance of self-disclosure, partner disclosure, and perceived partner responsiveness in interpersonal exchanges. Journal of Personality and Social Psychology, 74, 1238–51.
Laurenceau, J., Barrett, L. & Rovine, M. (2005). The interpersonal process model of intimacy in marriage: a daily-diary and multilevel modeling approach. Journal of Family Psychology, 19, 314–23.
Leigh, H., Streltzer, J. (2007). Handbook of Consultation-Liason Psychiatry. New York: Springer.
Leitch, M. (2007). Somatic experiencing treatment with tsunami survivors in Thailand: Broadening the scope of early intervention. Traumatology, 13(3), 11.
Luminet, O., Bouts, P., Delie, F., Manstead, A. & Rime, B. (2000). Social sharing of emotion following exposure to a negatively valenced situation. Cognition & Emotion, 14, 661–88.
Lumley, M., Sklar, E. & Carty, J. (2012). Emotional disclosure interventions for chronic pain: from the laboratory to the clinic. Translational Behavioral Medicine, 2, 73–81.
Maldavsky, D. (2008). Sobre las investigaciones de caso único y las combinaciones entre ellas, con especial referencia a la perspectiva de la intersubjetividad. Estudios sistemáticos con el algoritmo David Liberman (ADL). Revista Clínica e investigación Relacional, 2 (1), 185-219.
Miller-Karas, E. & Leitch, L. (2013). Trauma Resource Institute: Trauma Resiliency Model. Claremont, California: Trauma Resource Institute.
Morley, S., Doyle, K. & Beese, A. (2000). Talking to others about pain: suffering in silence. En: Devor M, Rowbotham M, Wiesenfeld-Hallin Z. (Eds.), Proceedings of the ninth world congress on pain: progress in pain research and management (pp. 1123–1129). Seattle: IASP Press.
Piliavin, J., Dovidio, J., Gaertner, S., & Clark, R. (1981). Emergency intervention. New York: Academic Press.
Pincus, H. (1987). Marketing consultation-liaison psychiatry. General Hospital Psychiatry, 9 (5), 347-349.
Preston, S. & de Waal, F. (2002). Empathy: Its ultimate and proximate bases. Behavioral Brain Sciences, 25, 1–72.
Preston, S., Bechara, A., Damasio, H., Grabowski, T., Stansfield, R., Mehta, S., Damasio, A. (2007). The neural substrates of cognitive empathy. Society of Neuroscience, 2 (3–4), 254–275.
Reis, H. & Shaver, P. (1988). Intimacy as an interpersonal process. En Duck, S. (Ed.), Handbook of interpersonal relationships (pp 367–89). Chichester: Wiley.
Rogers, C. (1951). Client-centere therapy. Boston: Houghton Mifflin Co.
Ruby P. & Decety J. (2004). How Would You Feel versus How Do You Think She Would Feel? A Neuroimaging Study of Perspective-Taking with Social Emotions. Journal of Cognitive Neuroscience, 16(6), 988-999.
Rushton, C., Kaszniak, A. & Halifax, J. (2013) A framework for understanding moral distress among the inter-professional team. Journal of Palliative Medicine, 16(9), 1074–1079.
Santos N., Slonczewski T. & Prebianchi H. (2011). Interconsulta psicológica: demanda y asistencia en hospital general. Psicologia em Estudio, 16(2), 325-334.
Schoenrade, P. (1981). Emotional and motivational distinctions between imagining oneself and imagining another in a need situation. (Tesis de mestría inedita). University of Kansas, Lawrence.
Singer, T., Seymour, B., O’Doherty, J., Kaube, H., Dolan, R. & Frith, C. (2004). Empathy for pain involves the affective but not sensory components of pain. Science, 303(5661), 1157–1162.
Stephens, M., Martire, L., Cremeans-Smith, J., Druley, J. & Wojno, W. (2006). Older women with osteoarthritis and their caregiving husbands: effects of pain and pain expression on husbands’ well-being and support. Rehabilitation Psychology, 51, 3–12.
Stiles, W., Shuster, P. & Harrigan, J. (1992). Disclosure and anxiety—a test of the fever model. Journal of Personality and Social Psychology, 63, 980–8.
Stoppiello, L. A. (2009). Estudio de caso único: vicisitudes en la selección de la muestra de una investigación doctoral. Subjetividssd y Procesos Cognitivos, 13(2), 224-246.
Stotland, E. (1969). Exploratory investigations of emphaty. En Berkowitz L. (Ed.), Advances in experimental social psychology (pp 271-313). New York: Academic Press
Takeshi, K., Yuri, M., Hideyo, K., Kengo, N., Mitsuru, K. & Ikuo, H. (2012). Sharing breathlessness: Investigating respiratory change during observation of breath-holding in another. Respiratory Physiology & Neurobiology, 180, 218– 222.
Tania, S. & Claus, L. (2009). The social neuroscience of empathy. Annals of the New York Academy of Sciences, 1156, 81–96.
Vidal y Benito, M. (2012). La empatía en la consulta. Buenos Aires, Argentina: Polemos
Vyskoilova, J.,Prasko J., & Slepecky, M. (2011). Empathy in cognitive behavioral theraphy and supervision. Activitas Nervosa Superior Rediviva, 53(2), 72-83.
Wicker, B., Keysers, C., Plailly, J., Royet, J., Gallese, V. & Rizzolatti, G. (2003). Both of us disgusted in my insula: the common neural basis of seeing and feeling disgust. Neuron, 40(3), 655–664.
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